Medical Assistance Specialist ; MAS​/AHSO Internal

This is a full-time permanent, remote position. Employees may occasionally be asked to attend an in-person meeting or event based on business needs.

This is an internal opportunity and is only open to current HCA employees.

All HCA employees are required to be Washington state residents upon their first day of employment.

This position leads a team of medical assistance specialists handling pharmacy authorizations by assisting with complex questions, performing quality reviews, and training staff on processes and procedures. They also liaise with other departments, including attending meetings with clinical and other Apple Health staff.

• Performs quality control within the Pharmacy Authorization Unit to ensure adherence to proper protocol and guidelines.
• Trains MAS3s to case manage each request for pharmaceuticals.
• Assists the supervisor and MAS3s in identifying, reviewing, and making final decisions on complex pharmacy authorization requests.
• Consults with management regarding pharmacy policies and procedures, problem solving, workflows, and public relations.
• Responds to on-line inquiries regarding pharmacy authorizations, policies, and procedures.
• Utilizes Provider One, CRM, Flex Rx, Right Fax, and Drug Rolodex to ensure a high volume of authorizations are processed accurately.
• Monitors providers identified as deviating from standards set by Pharmacy Program Section for compliance.

• You will lead a team as a subject matter expert.
• You will troubleshoot complex problems that require critical thinking skills.
• You will do a variety of tasks including coaching staff, managing the team’s SharePoint, and meeting with staff from across the division.

• Expertise regarding reviewing and understanding WACs and how they relate to this unit’s work.
• Ability to navigate and balance a high volume and variety of work.

Experience may have been gained through paid or unpaid activities. Please ensure any relevant experience defined below is outlined in your cover letter, resume, and application.

• Advanced Medical Assistance Program Expertise – Demonstrated knowledge of federal and state laws, regulations, policies, procedures, and program requirements applicable to complex medical assistance program issues and circumstances.
• Advanced Analysis and Problem Resolution – Demonstrated proficiency in analyzing complex, unusual, or escalated program issues, evaluating relevant information and requirements, and developing accurate and well-supported determinations, recommendations, or solutions.
• Technical Leadership and Guidance – Demonstrated expertise in providing technical leadership, guidance, consultation, and support to staff and stakeholders regarding complex program requirements, policies, procedures, and work processes.
• Training and Knowledge Transfer – Demonstrated ability to develop, deliver, or support formal training and provide coaching and technical instruction that promotes accurate and uniform application of program rules, policies, procedures, and requirements.
• Quality Assurance and Program Consistency – Demonstrated proficiency in reviewing and evaluating work for accuracy, quality, and compliance; identifying errors, trends, or inconsistencies; and recommending improvements to ensure consistent application of program requirements.
• Policy and Regulatory Interpretation – Demonstrated knowledge of interpreting complex policies, regulations, and program requirements, evaluating their impact on program operations, and communicating appropriate guidance to staff and stakeholders.

• Equity lens – All HCA employees are required to consider equity in their…